Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 35392 | CA |
NPI | 1083830673 |
---|---|
Provider Name | Dr. Peter Endo |
First Address | Torrance, CA 90505-3749 |
Second Address | Torrance, CA 90505-3749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |